what is a vbac?

VBAC stands for Vaginal Birth After Cesarean. Sometimes also referred to as a YBAC, or Yoni Birth After Cesarean. If you are planning a homebirth, it is called a HBAC, or Homebirth After Cesarean. I have attended women in hospital vbacs, as well as home vbacs. I have attended women who have had multiple cesareans who wanted to have a vbac or hbac. It can happen!

who can have a vbac?

There are very few women who are unable to have a vbac.The American Academy of Obstetricians and Gynecologists concluded in a 2000 report that the benefits of a vaginal birth after a cesarean outweigh the risks for many women. And the federal government has set a goal of 37% VBAC deliveries as part of its Healthy People 2010 objectives, up from the 28% rate reported in 1998. You are a good candidate for a vbac if:

• You have had one cesarean birth using a low transverse incision (also known as the "bikini incision").
• No medical reason exists for a cesarean delivery with this pregnancy (such as placenta previa, breech position, contracted pelvis, triplets or more, or active genital herpes).
• Your fetus is normal in size and in the head-down (vertex) position. (If breech, an external version should be attempted before a c-section if it is not an emergency.)
• You wish to have a vaginal birth.
• You have been told that you are having a low risk pregnancy.
• You are not going to have your labor augmented. (Augmentation increases the chance of uterine rupture.)
• You have access to a hospital that is equiped for an emergency c-section.

approaching your caregiver

Pregnancy, labor, and delivery are different for every woman and difficult to predict. Even if your first pregnancy required a cesarean, the next one may not. Overall, 60% to 80% of women who want a vbac succeed. This number would umdoubtedly increase if augmented and induced labors were not a factor. Remember, augmentation and induction carry their own set of dangers and should be avoided by women wishing a successful vbac.

If you caregiver has not already suggested that you are a good candidate for vbac, ask her/him candidly at your next appointment about your wishes. Some smaller hospitals are now not offering vbacs as malpractice insurance premiums rise and more and more parents are suing their hospitals. This also comes from pressure from ACOG (Amercian College of Obstetricians and Gynecologists) whose policy states that your Obstetrician must be with you (on the premises) during your entire labor, and most OBs do not want to labor sit. So, please take into consideration that your caregiver may be under pressure to NOT allow a vbac. This does not mean however that you do not have the right to have a vbac. If you caregiver is hesitant or even adamantly opposed, get a second or even a third opinion. If it is because of the hospital policy, you may need to change hospitals or caregivers. Don't give up. "Once a c-section, always a c-section" is no longer true.

cesarean section information

There is no dispute that some cesareans are necessary. If you have complete placenta previa, a true contracted pelvis, severe toxemia, or are carrying many babies, a c-section may be your best and safest childbirth option. Sometimes, an emergency will arise during your delivery that will necessitate a c-section, such as a prolapsed cord, transverse lie, or extreme fetal distress.

Or, some women will opt for a repeat c-section or first time c-section after carefully weighing their options. If women are to truly have freedom over their birth experience, than a c-section needs to be one of her options. She needs to be made aware however, that although huge advances in medicine have occured, compared to natural childbirth, a ceserean section carries many more risks. Before she consents to having a c-section, she needs to know the following:

• A baby born comfortably in the absence of labor pains, or few labor pains, has less ability to adjust to the uncomfortable and irritating outside world, and has a higher risk for developing dyspnea, i.e., difficulty breathing.
• During a normal vaginal birth, the baby's chest is pressed by the birth canal, pushing amniotic fluids and other secretions out of its lungs, but this action becomes weak in surgery. If the baby is parturient and healthy, problems rarely occur; if the baby is weak, it will have trouble spitting and develop dyspnea.
• After the birth, she may experience severe gas pains from having her abdomen opened up.
• Uterine contractions after the birth will be more severely painful as a result of the surgery.
• The mother should expect a longer recovery period after a c-section and more weariness/tiredness as a result of the anesthesia and operation.
• The incision on the uterus may heal well, but there will be a scar on the uterine muscle and the uterus may not recover to its original state. Most scarred areas are weak and occasionally become paper thin, which can rupture during the next pregnancy or labor.
• The danger for rupture increases when the uterus has been cut vertically because of placenta previa and cross birth (transverse presentation). Mothers who have received vertically cut cesarean sections should remember this and remind their physician, in the event of subsequent births.
• Your insides will feel like they are falling out the following day after surgery, but they are held in place by several layers of stitches and staples.
• Chances are high that the next pregnancy will occur where the uterine incision was made, thereby increasing the possibility of placenta previa.
• If an embryonic sack grows on the outside of the incision region, there is a danger of hysterorrhexis (metrorrhexis) early in the pregnancy. Appropriate measures should be taken to avoid an extrauterine pregnancy (ectopic pregnancy).
• Women often receive abdominal incisions (celiotomy, laparotomy) because of uterine and ovarian abnormalities or extrauterine pregnancies. A cesarean section adds to the overall number of surgeries. Most women who undergo a cesarean section receive another with each additional pregnancy, continuously burdening the body. Therefore, it is recommended that a natural birth be attempted with the first pregnancy.
• Women run 5 to 7 times the risk of death with c-section compared with vaginal birth.14,29
• Complications during and after the surgery include surgical injury to the bladder, uterus and blood vessels (2 per 100),30 hemorrhage (1 to 6 women per 100 require a blood transfusion),30 anesthesia accidents, blood clots in the legs (6 to 20 per 1000),30 pulmonary embolism (1 to 2 per 1000),30 paralyzed bowel (10 to 20 per 100 mild cases, 1 in 100 severe),30 and infection (up to 50 times more common).
• One in ten women report difficulties with normal activities two months after the birth, and one in four report pain at the incision site as a major problem.9 One in fourteen still report incisional pain six months or more after delivery.
• Twice as many women require rehospitalization as women having normal vaginal birth.
• Especially with unplanned cesarean section, women are more likely to experience negative emotions, including lower self-esteem, a sense of failure, loss of control, and disappointment. They may develop postpartum depression or post-traumatic stress syndrome.9,20,25,31 Some mothers express dominant feelings of fear and anxiety about their cesarean as long as five years later.
• After the surgery, women may experience numbness and itching around and at the incision site.
• Women having cesarean sections are less likely to decide to become pregnant again.

What happens in a c-section?

Obviously, in a c-section, it is a major surgery that has dangers but can have life saving benefits, depending upon your situation. However, if you are faced with the possibility of a c-section, you may wish to know what to expect before you get there. Coming to grips with what you face will help you in the long run towards a better birth experience and towards a faster recovery. Here is a breakdown of what happens in the surgery, step by step:

• An IV line started.
• Pre-operative medications may be used to calm you down. They can also make you groggy, if you wish to avoid them, be sure that you discuss this with your operative team.
• An antacid for your stomach acids, to attempt to reduce the dangers should you aspirate during the surgery (Generally not a problem with regional anesthesia {epidural/spinal}.).
• Monitoring leads (heart monitor, blood pressure, oygen)
• Anesthesia (Spinal anesthesia is recommend for several reasons when epidural isn't previously in place, or the cesarean is planned.)
• A catheter inserted to collect urine (insist that this is done after your anesthesia so that you don't feel it!)
• Anti-bacterial wash of the abdomen, and partial shaving of the pubic hair
• Draping of legs, upper torso, screen put in place.
• Skin Incision (Low transverse is the most common.)
• Uterine Incision (Low transverse is the most common.)
• Uterus is pulled apart further by hand to allow delivery.
• Breaking the Bag of Waters.
• Disengage the baby from the pelvis.
• Birth!!!! (Accomplished by hand, forceps, or vacuum extractor)
• Suctioning of baby.
• Cord Clamping and cutting.
• Newborn Evaluation (If baby is ok, they will bring him/her to you to look at, ask in advance for this to be done asap and have dad or partner hold baby)
• Placenta removed
• The Uterus is taken out of the abdominal cavity, examined, and then sutured.
• The Uterus is then placed back inside the abdominal cavity.
• Skin Sutured (Usually the top layers will be stapled and then the staples are removed within 2 weeks.)
• Some women may have special drains to help remove fluids that are collecting on the inside.
• Dressings applied.
• Draperies removed and blankets put in place.
• Postoperative medications administered(Ask about Duramorph.)
• You will be moved to the Recovery Room (If the baby is able s/he can go with you.)

There are ways to make a c-section more baby and family friendly.

• Bringing your partner (and your doula) to the birth
• Using a mirror during the birth or having the screen dropped
• Using music during the delivery of your choice
• Talking to your baby during the delivery, letting him/her know that you can't wait for him/her to be here
• Pictures, videotaping
• Partner cutting the cord after it stops pulsing
• Delaying bathing the baby, so that you can give baby his/her first bath later
• No eye ointment or drops for the baby
• No pacifiers or glucose water
• Minimal separation from the baby (none if baby is not in danger)
• Pediatric exam in mother's room
• Breastfeeding in the recovery room immediately after the birth
• LeBoyer bath after birth (best if done by your baby's dad or your partner)
• Freeing one of your hands to touch and hold the baby after birth
• Partner carrying the baby to the warmer after birth (if warmer not needed, having dad/partner carry the baby to your room after birth for rooming in)
• If you are feeling up to it, have a small birthday party or dedication for your baby before you leave the hospital

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Disclaimer:The materials provided at this site are for informational purposes and are not intended for use as diagnosis or treatment of a health problem or as a substitute for consulting a licensed medical professional.